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et du revenu du Canada
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DECLARATION OF CONDITIONS OF EMPLOYMENT
z
The employer must complete Part A and Part B of this form in order for the employee to deduct employment expenses from his or her income.
z
The employee does not have to file this form with his or her return, but must keep it in case we ask to see it.
z
For more information, see guide T4044, Employment Expenses, or Interpretation Bulletins IT-352, Employee's Expenses, Including Work Space in
Home Expenses, and IT-522, Vehicle, Travel and Sales Expenses of Employees.
Part A – Employee information
Tax year
First name
Last name
Social insurance number
Business address
Home address
Job title and brief description of duties
Part B – Conditions of employment
1. a) Did this employee's contract require the employee to pay his or her own expenses while carrying out the
duties of employment?
b) If no, the employee is not entitled to claim employment expenses. No other questions are required to be
answered, but you still have to complete the Employer Declaration on page 2 of this form.
2. a) Did you normally require this employee to work away from your place of business or in different places?
Yes
No
Yes
No
b) If yes, what was the employee's area of travel (be specific)?
3. Indicate the period(s) of employment during the year. From:
To:
(Year)
(Month)
(Day)
(Year)
(Month)
(Day)
If there was a break in employment, specify dates.
4. a) Did this employee receive a motor vehicle allowance?
b) If yes, indicate:
i) the amount received as a fixed allowance, such as a flat monthly allowance.
ii) the per km rate used
($/km), and the amount received.
iii) the amount of the allowance that was included on the employee's T4 slip.
c) Did this employee have the use of a company vehicle?
Yes
No
Yes
No
Yes
No
$
$
$
5. a) Did this employee receive a repayment of the expenses he or she paid to earn employment income?
b) If yes, indicate the amount and type of expenses that were:
Amount
i) received upon proof of payment.
$
ii) charged to the employer, such as credit card charges.
$
iii) included on the employee's T4 slip.
$
Type of Expense
6. a) Did you require this employee to pay other expenses for which the employee did not receive any allowance or repayment?
b) If yes, indicate the type(s) of expenses.
Yes
No
7. a) Did you pay this employee wholly or partly by commissions or similar amounts according to the volume of sales made
or contracts negotiated?
Yes
No
b) If yes, indicate the amount paid ($
) and the type of goods sold or contracts negotiated (
).
c) Is there a business development account or other similar commission income account available from which the
employee's employment expenses are paid or reimbursed?
Yes
No
d) If yes, is the commission income from this account included in box 14 of the T4 slip?
Yes
No
Yes
No
8. a) Did you require this employee to be away for at least 12 consecutive hours from the municipality and metropolitan area
(if there is one) of your business where the employee normally reported for work?
b) If yes, how frequently?
T2200 E (05)
(Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca ou au 1 800 959-3376.)
9. a) Did you require this employee under a contract of employment to:
z rent an office away from your place of business or use a portion of his or her home?
z pay for a substitute or assistant?
z pay for supplies that the employee used directly in his or her work?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
11. a) Did you require this apprentice mechanic, as a condition of employment, to purchase and provide tools that
were used directly in his or her work?
Yes
No
b) If yes, do all of the tools itemized on the list provided to you by the employee satisfy the condition described
in 11a)? Please sign and date the list.
Yes
No
Yes
No
Yes
No
b) Did you or will you repay this employee for any of the expenses in 9a)?
c) If yes to 9b), indicate the type of expense and amount you did or will repay.
10. a) Did this employee work for you as an apprentice mechanic?
b) If yes, was this employee registered in a program established under the laws of a province or territory that leads
to a designation under those laws as a mechanic licensed to repair self-propelled motorized vehicles?
12. a) Did this employee work for you as a forestry worker?
b) Did this employee, as a condition of employment, have to provide a power saw (including a chain saw or tree trimmer)?
Employer Declaration
I certify that the information provided on this form is, to the best of my knowledge, correct and complete.
Name of employer (print)
Date format: yyyy mm dd
Date
(
Name and title of authorized person (print)
)
Telephone
Signature of employer or authorized person
Note
Please make sure that the name and telephone number of the authorized person is clearly printed in case we need to call to verify information.
Printed in Canada
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